Posts Tagged ‘healthy’

By Suzanne Martin, PT, DPT

Got sunlight? Of course. Well, maybe—depending upon the season, how far you are from the equator, and how much sunblock is in your moisturizer. We all know that a little sunlight can make us feel better, and most of us know that it’s a source of Vitamin D. Yet how many dancers do you see with a George Hamilton tan that’s not painted on? In my studio experience I’ve seen many a pasty face; even in Miami Beach, Phoenix, or San Diego, beaucoups hours of teaching, rehearsing and performing can keep even the most devoted sun-child indoors. And what about the ozone-layer scare? Most dancers with experience (read: age) tend to wear sunscreen not just for melanoma prevention but also out of vanity. We all want to stay wrinkle free as long as possible.

Why does Vitamin D matter? For starters, it plays an important role in bone density, especially in women. The American College of Sports Medicine and the International Association for Dance Medicine and Science have made groundbreaking statements about the incidence of amenorrhea, osteoporosis, and stress fractures in female athletes and dancers. It is now well known that dancers, especially the young, need to eat enough calories to sustain the energy level necessary to excel in dance and avoid the risk of imminent stress fractures and down-the-line osteoporosis that often accompanies low blood levels of estrogen. Now we have one more important piece in the well-dancer/strong-bone puzzle—Vitamin D—thanks to recent research spearheaded by Dr. Michael Holick and others at Boston University School of Medicine.

What is a vitamin, anyway?
Technically, a vitamin is a catalyst for necessary chemical reactions that make our cells and tissues function well. “Vitamin D” is a nickname because now we know that it is actually a full-blown hormone, a chemical messenger with functions that go beyond the all-important role of bone manufacture.

Sources of Vitamin D
Most people now know something about the so-called “sunshine vitamin.” The traditional belief was that we get enough Vitamin D from sunlight. But after health officials discovered Vitamin D deficiency’s link to bone problems in sun-deprived slum dwellers in Warsaw and London in the late 1800s and early 1900s, D began its roughly 100-year history as a food additive into such products as milk and juice. Severe deficiency creates undeveloped bones in children (rickets) and fractures in adults (osteomalacia).

According to Holick, in about 1930 U.S. government regulations slackened the requirements regarding Vitamin D as an additive; the problem was solved. But was it? Frightening research from Dr. Holick tells us it likely is not. His recent studies on human blood levels at various latitudes, the true amount available in milk and juices, blood-level findings across skin color, and the amount of sunshine that actually passes through glass are reason enough to pay attention.

Holick’s argument for Vitamin D supplementation to avoid deficiency is profound. The farther you are from the equator, the less D you absorb. Plus, you need a large amount of leg, arm, and facial skin exposure, for about 15 minutes 4 times a week, to get the minimum. The amount found in juices and milk often varies from the stated packaging. Dark skin colors and the filtration effect of glass block the beta ray exposure necessary for Vitamin D production.

Dancers at risk
Both baby ballerinas and seasoned masters appear to be at risk for a double whammy of shaky bone health. Young dancers run the risk of low estrogen levels and body weight having a negative impact on bone production and density; add the factors of geographic location, skin color, and limited exposure to the outdoors to create a tricky skeletal situation. Older dancers share those geographic, skin, and cultural issues, and those who are post-menopausal have a recipe for fracture if they don’t take preventative measures. In younger dancers, think stress fractures; in older dancers, think hip replacement. Add the fortunately going-out-of-style cultural behavior of smoking and/or consuming sodas to either demographic, and you’ve got a surefire recipe for disaster.

What if you don’t care about bone health? Isn’t that an abstract idea? Don’t those problems happen to other people? Not really. All dancers can relate to muscles. Muscles equal technique; muscles dictate control. Muscles determine how you look onstage and whether you have the strength to execute an entire variation. Yet the real zinger is that muscles can only be as strong as the bones they pull on. Soft, hollow bones mean little muscle strength. In the flexible body type of the typical dancer (called hypermobility), muscle strength translates into less joint pain, fewer sprains, and generally less body pain. And to have strong muscles you need strong bones.

How much is enough?
Are all dancers doomed? The good news is that Holick’s research caused other researchers to jump on the Vitamin D bandwagon, and they have some concrete recommendations. The recommended daily allowance has been bumped up to 1,000IU from its previous levels of 400IU for children over age 4 and 600IU for postmenopausal women. Another recommendation is to have your blood level of D2-OH measured; a minimum value of 40 ensures the bone strength necessary for good muscle tone.

An adequate amount of Vitamin D, along with the recommended daily allowance of 1,200 to 1,500 milligrams of calcium for adolescent dancers and post-menopausal dancers, respectively, is crucial to bone deposition. There is now evidence of Vitamin D’s influence on other important physiological functions that have an impact on cancer risk and immune disorders. That means that everyone, especially those watching their caloric intake, needs a multivitamin supplement for basic nutrition.

An often-asked question is how to get it naturally in food sources. The obvious ones are D-fortified milk and juices. Unfortunately Vitamin D occurs best in cod liver oil, not a favorite food for most of us. That’s why supplementation makes sense. Look for the D3 form in supplements and heed the 1,000IU level for a daily dose.

The farther you are from the equator, the less Vitamin D you absorb. Plus, you need a large amount of leg, arm, and facial skin exposure, for about 15 minutes 4 times a week, to get the minimum.

Still not convinced?
Dr. David Feldman of Stanford University School of Medicine’s endocrinology division tells us that Vitamin D is now recognized to have expanded activity beyond its traditional role in prevention of osteoporosis, rickets, and osteomalacia. Recent evidence points to its role in the prevention of autoimmune diseases such as fibromyalgia (considered a muscle endurance problem in physical therapy), and the development of certain cancers.

Feldman correlates distance from the equator with the incidence of breast, colon, and prostate cancers. This is good information for boomers, and especially to those of us in Northern California. Adding some D to the diet could decrease the usual cancer risk associated with our lack of sunlight and advancing age. Vitamin D promotes natural cell death, a problem with self-perpetuating cancer cells, and blocks the blood supply development needed by growing cancer cells.

What’s the bottom line?
Wear your sunblock when enjoying outdoor activities, but do try to get 10 to 15 minutes of sun exposure several times per week. Get your blood level checked so that you know your baseline. Take the recommended daily supplement to ensure a good blood level. Be sure to take calcium; D doesn’t work alone. All dancers should take 1,200 to 1,500 milligrams of calcium per day, coupling it with magnesium for maximum absorption.

The take-home message is that we all want to keep dancing, and we have enough information to know how. A strong infrastructure, our skeleton, is our insurance to keep dancing into the sunset.

I have faith in you.

Food tips for a hectic lifestyle

By Suzanne Martin, PT, DPT

Staying healthy while being in a studio all day and eating on the run is one enormous challenge. And wouldn’t it be great to go beyond maintenance by achieving optimal health?

People who live the performing-arts life prolong their youth by being so active in their 20s and 30s. Yet what an effect it has on the body. Dancers who start at age 8 or 10 and pursue a teaching or performance career have packed in a lot of mileage by age 30. And just think about 40- and 50-somethings! So if you’re going to go into the sunset in your dancing shoes, how can you stay the course?

Any worthwhile project requires R&D, research and development. Knowledge is powerful. But a little knowledge plus the plethora of trendy eating diets, articles, and supplements can be dizzying. Thinking simply, life boils down to three physical requirements: water, food, and rest. How do you regulate, and enhance, all three while multitasking?

When it comes to being on the go, strategy pays off. One of the biggest pitfalls for even the most dedicated health nut is being caught off guard. Plan, plan, and plan some more, so that you not only have nutrients and water within your grasp but also time for rest. Let’s look at water and food. Being nourished and hydrated are two great ways to boost your energy level and keep up with a busy lifestyle.

All-essential water
Drinking plenty of water is one of best ways to stay afloat. Your body is 75 percent water; losing as little as 2 percent of that can cause foggy thinking. Physical performance starts to decline. Slowness can be dangerous when you need to be mentally alert: driving, crossing the street, bicycling. Slurring words impairs your ability to command authority and confidence. Slowed reactions make preparing a class, organizing, and doing analytical tasks take longer than necessary.

To make sure you get enough water in your busy day, drink one tall glass in the morning and one before bed. Have another glass if you get up during the night. In general the advice is to drink eight glasses per day, although the new thinking is that consuming water-rich foods such as fruits and vegetables contributes to this amount.

Try keeping a pitcher of water available with sliced lemons or strawberries in it for an extra lure. When traveling, fill your own big bottle or buy one after you pass security at the airport. We often mistake thirst for hunger, so next time you feel a hunger pang, reach for a water bottle before heading to the fridge.

Dancers lose a significant amount of water when performing under the lights, and they feel it in their legs. But it doesn’t happen only onstage—that heavy-leg feeling you sometimes get from teaching and rehearsing means you’re getting dehydrated. Another way to stay hydrated is to take Epsom salts baths. Mix about a half-cup of salts in a warm bath to hydrate and soothe muscles. They’re especially helpful after a flight.

We often mistake thirst for hunger, so next time you feel a hunger pang, reach for a water bottle before heading to the fridge. 

Hydrate and energize
Another quick energy/hydration tip for morning jumpstarts, afternoon lows, and jet lag is Emergen-C®. A combination of vitamins and minerals available in health food, drug, and grocery stores, each packet has 1,000 milligrams of Vitamin C. The Joint Health formula includes glucosamine, recommended for dancers because it may protect joint cartilage.

Emergen-C’s carbonated formula fizzes up in water, which gives it a quicker entry into the gut. (That’s why champagne gets you high so much more quickly than wine.) The minerals potassium and magnesium replenish electrolytes, which are essential to recovery after exercise. If you can refrigerate it, try adding it to a homemade carrot juice smoothie. The carrot juice stabilizes blood sugar and the fruit gives a quick jolt of energy.

Meals
What about solid food on the go? Again, it breaks down to three categories: home packaging, pre-packaging, and restaurant food. With food, there’s truth to the adage that if you want anything done right, you have to do it yourself.

Strategy pays off when you crave a meal. As I mentioned in the January issue, preparing food—chicken, salmon, or tofu for protein, plus veggies and a dressing—in containers for the upcoming week will ensure lean, healthful meals. Taking a salad with you is easy. Combine the salad and eat it with green tea, which contains antioxidants and is a safe metabolic accelerator (weight-loss agent). It also has caffeine for a boost of energy. If you can’t mix the ingredients on site, fix a single-serving salad in the morning and take it with you. Try cottage cheese, fruit (strawberries, papaya, avocado), walnuts, and low-fat crackers for a quick, easy-to-digest lunch.

Energy bars
What about the darling of pre-packaged food, the energy bar? There are a staggering 900-plus bars on the market, ranging widely in nutrient content, ingredient quality, and calories. Select a bar that has protein, carbohydrate, and fat in a ratio of, respectively, about 40/40/20. It should be high in fiber and low in saturated fat, with no trans-fat. A bar with 200 to 300 calories can substitute for a meal, especially when combined with a glass of dairy or soy milk and a piece of fruit.

But should bars make up most of your meals? Registered dietician Nancy Clark, in private practice at the Boston area’s Healthworks Fitness Center, has plenty to say about energy bars: Look for quality bars made from whole foods such as fruits, nuts, and fiber. Analyze the name—some bars may be dessert substitutes rather than healthful, compact nutrition. Remember, by law the first ingredient listed is the most plentiful.

Choose a bar that is as unprocessed as a processed food can be. My favorite does have a dessert name: “Cherry Pie” from Larabar. However, this brand is all fruit and nuts, with no added sugars, fillers, supplements, or flavorings. They are gluten- and dairy-free and kosher to boot. Even the most discerning vegan (but not those with peanut allergies) can partake of these raw bars. Clif® is another high-quality brand that is organic and trans-fat free, although it’s higher in fat content than others.

Another pre-packaged fast food I cannot live without is oat cakes (often confused with hockey pucks). I carry them on trips for an inexpensive breakfast or quick meal when stranded at airports. Listed as having 2 points in the WeightWatchers® system, they might be sweet for some tastes.

Variety: key to good nutrition
Clark cautions that eating bars on the run is one thing and good, wholesome nutrition is another. She advocates consuming 20 to 30 different foods per week. Variety ensures that we get the nutrients, vitamins, and minerals necessary for optimal functioning. And don’t forget those five portions of fresh fruit or vegetables each day.

Eating a variety of foods also ensures that we don’t develop allergies over time to cultural favorites like wheat. Counting on energy bars to regulate your caloric intake will get you into a nutritional rut, and eating them in lieu of desserts or whole foods will take away the skill of portion control when navigating social events and emotional highs and lows.

The restaurant trap
One surefire way to double your weight is to eat every meal in a restaurant; think the freshman 20, or as my relatives in New Orleans say, the Katrina 40. When you’re traveling, or even just busy, it makes sense to eat out—but restaurant fare can pack in all kinds of hidden calories, saturated fats, and other enemies of healthy eaters. Restaurants have improved their listing of heart-healthy meals, but they may add calories, salt, and sugar to enhance flavor. Another difficult ingredient is MSG, which provides flavor but can cause headaches and water retention.

The best strategy when dining out is to not eat all the bread on the table. Instead, order a bowl of soup—the warm liquid feels good in the stomach and the volume helps you feel full. Avoid cream soups unless you’ve really got to have that chowder on a wintry day. For entrees, choose grilled meat or fish and vegetables over combination foods such as lasagna, cream dishes such as fettucine alfredo, or even pizza.

What to eat when
The order in which you eat makes a difference in literally trimming the fat. Eat meat and veggies before baked potatoes, rice, and french fries. The starches are the fillers of nutrition, depending upon your caloric needs. If you are a farmer, or an endurance athlete like Lance Armstrong, you should eat pancakes, bread, eggs, bacon, and grits for breakfast—easily a 1,000-calorie meal.

Yet for most people, filling up on starches prevents you from eating the foods with the most nutritional value, such as fresh vegetables for vitamins and roughage, protein for building muscle and bone, and minerals. Another mind-blowing fact, according to performance researcher Dr. Clyde Wilson, is that the liver can metabolize only small amounts of food at a given time. The rest gets stored away for future use—read: fat.

Vitamin D
Next month’s column will focus on the crucial role of Vitamin D for a strong musculoskeletal system and in helping our bodies cope with cancer risk and autoimmune disorders. So stay tuned for more on Vitamin ‘D’ancing!

I have faith in you.

Quick Tips for Healthy Eating

• Keep hydrated. Drink a glass of water first thing in the morning and again before bed. Aim for eight glasses a day. Make water more enticing by adding sliced lemons or strawberries. Try Emergen-C for an energy and nutrition boost.
• Use energy bars sparingly, and choose those with a 40/40/20 ratio of protein, carbohydrate, and fat. Opt for the least-processed bars on the market, such as Larabar and Clif bars. Oat cakes are another good option.
• Prepare healthy meals ahead of time to grab and go: Proteins (salmon, chicken, tofu, cottage cheese), nuts, veggies, and fruits make good salads and snacks.
• In restaurants, choose lean meats, soups, and veggies. Eat the protein and vegetables first to avoid filling up on carbohydrates like bread and potatoes.
• Take a good-quality multivitamin that includes 1,000 milligrams of Vitamin D.

Cross-training, body awareness, and old-fashioned common sense mean fewer injuries among students

By Darrah Carr

“Break a leg!” The theatrical well wish for actors and dancers has an irony that often escapes young performers. Indeed, for most young, healthy dancers, the possibility of injury feels remote and doesn’t factor greatly into their daily routine. For their older, more experienced teachers, however, the reality of injury and the desire to prevent it create a serious responsibility.

Sarita Zuniga of Sarita’s Dance Studio leads students in a prerehearsal yoga session, in which she encourages the integration of mind and movement. (Photo by Marina Zuniga-Johnson)

Fortunately, for as many potential problems that dancers can face, there exists an equal number of precautions that teachers can take. To begin with, teachers must establish a healthy working environment within the studio, taking into consideration the need for safe physical facilities as well as for strong emotional support.

As Richard d’Alton, director of International Ballet of Houston, notes, “the artistic director is responsible for having good flooring. Dancing on concrete or wood with no marley is an archaic thing of the past. Thank goodness our standards have come a long way since then!” Having a well-stocked first-aid cabinet with plenty of ice on hand is another must for studio owners, as are operating hours that reflect a balanced, realistic schedule. “Overwork, multiple private lessons, and late night rehearsals are not necessary,” d’Alton says. “Dancers must be considered as human beings. And, as human beings, we all shut down at some point during the day. There is no need to go until 10 p.m. I believe in quality rather than quantity of instruction.”

Balancing the studio schedule by offering a wide variety of classes can also reduce injuries related to overuse. Sarita Zuniga, owner of Sarita’s Dance Studio in San Antonio, TX, explains, “We aim to have a well-rounded, balanced program and encourage the students to try different disciplines of dance. On Mondays we offer ballet and jazz; on Tuesdays it is folklorico; on Wednesday nights we have flamenco, and so on. If the students can do different movements every day, then they are not constantly relying on the same muscle groups and they don’t run as high a risk of injury from overuse.”

Studios with a more singular focus can also promote balanced musculature by encouraging their students to cross train. Zola Dishong, who runs Contra Costa Ballet in Walnut Creek, CA, along with her partner, Richard Cammack, advocates Pilates for her population of serious classical ballet students. “Bringing Pilates into the studio has been great because the philosophy of the class is all about injury prevention,” Dishong says. “You can strengthen any weaknesses and even work through an injury with Pilates.”

D’Alton encourages his ballet dancers to seek additional Pilates training outside of the studio and to spend time lifting weights as well. “Boys especially need weight training,” he says. “I don’t want them to be the size of champion prize fighters, of course. But they must be strong enough to partner the girls correctly. It is another means of injury prevention.”

Zuniga enhances her dancers’ training with yoga. “We always do 30 to 40 minutes of yoga before beginning rehearsal. We play soothing music, lower the lights, and meditate a bit so that the dancers can start listening to their bodies. I try to inspire them to integrate their whole mind into the movement,” she explains. “I’ve seen a big change in the dancers. Yoga strengthens their core and balances their muscles. In dance, many problems stem from overuse injuries. If dancers are straining their quads, for example, then yoga can balance that by lengthening their hamstrings.”

A studio owner’s efforts to create a healthy working environment must be maintained by the entire teaching staff. Diane Pippen, who co-owns Diamond Dance Center in Forrest Hill, MD, along with her sister, Barbara Peterson, believes that faculty education is of primary importance for injury prevention. “If you have a big faculty, you must sit down with them and review teaching expectations in terms of the physical developmental stages that children go through and the anatomical principles that apply. Teachers have to be on the lookout for things like pronation and hyperextension, and they must know what the proper anatomy is,” Pippen says. “Teachers also have to be aware of growth-spurt injuries such as problems with ligaments and tendons. As girls hit puberty and their hips widen, for example, we start to see problems with pronation, especially in the knees. Teachers can’t force a perfect fifth position on those kids.”

 ‘Bringing Pilates into the studio has been great because the philosophy of the class is all about injury prevention. You can strengthen any weaknesses and even work through an injury with Pilates.’ —Zola Dishong

Pippen cites a number of anatomical variances among students that can lead to injury if not properly monitored, including tibial torsion, hyperextended knees, shin splints, hip popping, pelvic tipping, and ankle issues involving the peroneal and posterior tibialis tendons. She believes that students must be made aware of the unique, individual structures of their own bodies. “Children need to be educated about their own bodies and made to understand that ‘My body does this, but not this,’ ” Pippen explains. “The culture at the studio needs to be supportive enough that students feel comfortable speaking up [about physical concerns] and modifying certain movements if need be.”

Whatever the style of dance, certain movements tend to lead to injury more than others. Teachers must be aware of potential pitfalls within the given vocabulary and take precautions to demonstrate those steps safely. Dishong recommends introducing new petit allegro jumps at the barre so that students become familiar with the intricacies of the steps before moving to the center. D’Alton suggests that teachers set a goal for the day and then build the structure of the class accordingly. “You can’t do big jumps before small jumps. You can’t make dancers go up on pointe or do anything in the center until they are properly warmed up,” he notes. “We don’t do grand pliés until the middle of the barre. They are bad for you in the very beginning of class. And, I never encourage grand plié in fourth. It is a position we don’t use very often in ballet anyway, and it causes unnecessary strain.”

Heightened body awareness and a thorough education can extend to the waiting room, where pamphlets and articles on injury prevention can be made available to students and their parents. The International Association of Dance Medicine, the American Council on Exercise, and Deborah Vogel’s “The Body Series” are just a few invaluable resources for teachers to draw upon.

“Many times parents don’t know how to help a child who is complaining of pain,” Zuniga notes. “We educate both dancers and their parents on the RICE method (rest, ice, compress, and elevate), and we encourage Epsom salt soaks for minor aches and pains. We also explain that if the body is tired and not getting proper nutrition, then the chances of injury increase. Rest, nutrition, and injury prevention are all connected. Many parents don’t understand this.”

When addressing both parents and students, d’Alton stresses the importance of allowing time to warm up even before class begins. “It is not OK for a student to sit in the car for 40 minutes, or even 15 minutes, and then run into class,” he says. “Students shouldn’t arrive 2 minutes before class time, or, even worse, 5 minutes after class begins.”

Many teachers also advise families about the risk of injury from non-dance–related activities. Dishong notes, “Nine times out of ten, when a dancer comes to me with an injury it is from gym class, running track, or some other kind of sports activity.”

Zuniga too recognizes the prevalence of sports injuries. “Coaches tend to be more abusive to the body than instructors in the fields of dance or fitness,” she says. “They can have a mentality of ‘No pain, no gain,’ which really is the philosophy of the past.”

Even when students get injured outside of the studio, dance teachers are often sought out for advice. “Parents tend to think that you know everything about the body, so they’ll call and ask your opinion even if the child got injured in school,” Zuniga says. “I’ll say, ‘Call a doctor; I’m not qualified.’ Then I’ll always refer them to a medical professional.”

Often dance teachers act as important facilitators among an injured dancer, a concerned parent, and a doctor. “I’m not qualified to diagnose a dancer. No teacher should attempt to do that,” d’Alton states. “It is my job to ensure that an ache or pain doesn’t turn into something more serious. I have to make sure that if something is hurting, dancers are being honest with themselves and are also letting us know. Dancers are very motivated people. We know that they always want to be in the studio. But if they are in pain, then the first thing they need to do is to take a few days off.” If the pain is severe or persistent, d’Alton insists that the dancer see a doctor in order to determine whether an X-ray or MRI is needed. He’ll also serve as the dancer’s advocate. “If I don’t agree with the doctor’s diagnosis, then I’ll encourage them to seek a second or even third opinion,” he says.

Many studios develop relationships with local medical professionals who specialize in dance medicine, sports medicine, or physical therapy. These specialists are often more helpful in treating an injured dancer than pediatricians or other general practitioners. Pippen, whose own background as a nurse comes in handy when addressing her students’ injuries, says, “We do have to counsel our parents to see a sports medicine doctor or one who has a dance background. We find that ‘regular’ doctors frequently do not understand the needs of dancers; their first inclination is to put them on crutches, in huge braces, or completely off dance when ‘relative rest’ and other treatments are warranted. We also find that some doctors do not always explain the diagnosis to the parent or the child, which I do not agree with at all. I want them to understand what is going on and how to fix it.”

An injury often leads to a greater understanding of the body and can have a lasting impact on a dancer. “I’ve seen very positive results when girls return after an injury,” Dishong says. “They are forced to be more intelligent about their work, to work more slowly, and to make better choices. They are often better off for it.”

While guiding dancers along the road to recovery, d’Alton requires them to watch classes and rehearsals. “The dancers usually want to watch anyway. They always hate being away from the studio. They can learn so much by watching their teacher teach and by watching both the good and bad examples of their fellow students,” he says.

Easing into classes after an injury is important in preventing reinjury. D’Alton does not believe in putting recovering dancers back into their regular class schedule right away. For one, the other dancers in the class need to continue to be challenged and shouldn’t be held up by a recovering dancer’s slower pace. “Working with a recovering dancer requires a good deal of one-on-one time. I don’t mind going in early or staying late to help a dancer with specific exercises until they can be incorporated back into their regular class,” d’Alton says. “It is a slow process. As their teacher, you have to put all expectations aside. Let them know that they don’t need to prove anything; they just need to get better.”

The recovery process requires patience from the dancers, of course, but also from their parents. “Often parents are very driven for their child to succeed in dance,” d’Alton says. “But you can’t get a quick fix in this business. And there is nothing more important than the long-term health and safety of the dancer.”